Comparison of surgical outcomes of Fuchs endothelial dystrophy treated with penetrating keratoplasty, DSAEK or DMEK: A systematic review and meta-analysis

A systematic review and meta-analysis were performed to compare the surgical outcomes of penetrating keratoplasty (PK), Descemet stripping automated endothelial keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial dystrophy (FED). Twenty-eight studies involving over 18,000 eyes were included. Eligible studies provided comparative data on best-corrected visual acuity (BCVA), endothelial cell loss, graft survival, and complication rates. Study quality was assessed using the Cochrane Risk of Bias and GRADE criteria, and data were pooled using the DerSimonian–Laird random-effects model. DMEK demonstrated significantly better BCVA at 6 months and 1 year compared with DSAEK and PK. At 5 years, DMEK showed the lowest endothelial cell loss (56.8%) and highest graft survival (97.4%), with better outcomes than DSAEK (57.7%, 78.4%) and PK (60.9%, 54.6%). DMEK also had the lowest rates of graft rejection and secondary glaucoma. These findings support DMEK as the preferred surgical approach for endothelial keratoplasty in FED, as it provides improved visual outcomes, better graft survival, and fewer complications.